External

'CREATE/AMEND CLAIM COMMENTS' in the Claims Management application

PRACSYS provides a number of “alert” factors by its functional set-up of claim comments.  The 'Create/Amend Claim Comments' (CCOM/ACOM.CM) screen is available during a number of functions on PRACSYS.

Its primary purpose is to record details relating to any important facts about a claim.  It then has the capacity for any user to look at claim comment details when either reading about, or working with, the claim.

From the outset, comments may be entered against a claim.  Part of the process of creating a claim on the system is the optional recording of any comments which are considered important to management of the case.

Each comment is broken down by major and then minor categories.  When investigating claims, it is more likely that the following categories will be used:

CATEGORY & CODES

WHAT INFORMATION TO ENTER

B - BENEFITS

ALT (Payment alert)

Once information is entered here, a warning message will be given to anyone using the 'invoices' payment function.  Use only when payment of an invoice should be cautioned.

DRS (Dr, specialist info)

Add details about doctors or specialists treating the employee and specific and unusual treatment requirements.  This may be found on the claim form or from medical certificates and reports.

INV (Investigation)

This area is used when a claim is being investigated, and other users need to note that this is occurring.  The code may be used in conjunction with 'STP' or 'ALT', detailing why an investigation has commenced, and should include outcomes of the investigation.

REP (Report information)

If anything in a medical report should be noted, this area should be used.

STP (Stop payments)

Once information is entered here, an error message will be given to anyone entering invoices on PRACSYS.  Use only when invoice payment should be prevented, usually when a claim is being investigated.

C - CUSTOMER

DIS (Employer claim disagreement reasons)

Enter details relating to the Employer's reason for disagreeing with the claim, either from the claim form or a later statement.

DOC (Requests for documentation)

Use this code to enter details about any Employer requests for documents.  Also use where making requests under section 71 (1).

D - DETERMINATION

CSS (Cessation of claim)

Enter reasons for the decision to cease full or partial liability for the claim here.

REJ (Rejection of claim)

Enter reasons for the decision to reject full or partial liability for the claim here.

SUS (Suspension of claim)

Enter reasons for the decision to suspend full or partial liability for the claim here.

E - EMPLOYEE

FOI (Requests for documents)

Use this code to enter details about any employee requests for documents.  Enter comments also when section 58 has been used to request information, etc.

MSC (Miscellaneous employee issues)

Enter any miscellaneous information about the employee, such as changes of address, fraud issues, sensitive things that need noting and other general employee details.  Most of this information will come from personal knowledge of the employee or direct mail requests.

Comment screens are attached to the following functions:

  • Create/Amend/View Claim;

  • Create/Amend/View Incapacity;

  • Create/Amend/View Invoices;

  • Create/Amend/View Return to Work Plans; and

  • Create/Amend Reconsideration/AAT Request.

'Create/Amend/View Claim Comments' and 'Create/Amend/View Work Assessment Comments' are also available as separate business functions on the Claims Management menu.

NB.  Bear in mind that claim comments are able to be viewed by an employee or his or her representative as a section 59 request or under of the Freedom of Information Act.

As such, great care must be taken with what and how comments are written against claims.  Insensitive or tactless comments will be difficult to explain and may have long term repercussions for the whole organisation.